Training called key for finding biological terrorism

New doctors said to lack instruction on diagnosing ills

CHICAGO -- Trainee doctors misdiagnosed diseases caused by biological terror more than half the time, but an online program improved skills, a study has found.

If there were an attack, doctors' inability to isolate contagious patients with smallpox or the plague might increase the number of victims. ''The risk of spread goes up logarithmically," said a coauthor of the study, Dr. Stephen Sisson of the Johns Hopkins University School of Medicine in Baltimore.

The lesson of the 2001 anthrax attacks, when four patients were sent home without a diagnosis, has not been learned, Sisson said.

States and medical residency programs should require bioterrorism training for doctors, he said.

The study, published yesterday in the Archives of Internal Medicine, involved 631 doctors, mostly medical residents, or doctors in training, in 30 internal medicine residency programs in 16 states and in Washington, D.C.

The doctors took a first test, completed an online course, and then took another test.

On the first test, half the doctors misdiagnosed botulism; 84 percent misdiagnosed plague. A case of routine chickenpox was misdiagnosed by 42 percent of the doctors as smallpox.

''We've got a dangerous gap here and we need a much clearer strategic game plan," said Shelley Hearne, executive director of Trust for America's Health, which tracks the states' preparation for biological terrorism.

While it is encouraging that the Department of Homeland Security created the post of chief medical officer, Hearne said, funding for training remains a problem.

In fiscal 2005, Congress approved $252 million for a line item called ''health professions training activities" in the Health Resources and Services Administration. That line item was eliminated in President Bush's proposed 2006 budget, Hearne said.